Provider Demographics
NPI:1275525594
Name:CROUCH, THERESA VOGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:VOGEL
Last Name:CROUCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:VOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5901 MARINA BAY CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-5249
Mailing Address - Country:US
Mailing Address - Phone:817-654-3765
Mailing Address - Fax:
Practice Address - Street 1:2114 BAY COVE CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-5201
Practice Address - Country:US
Practice Address - Phone:817-654-3765
Practice Address - Fax:817-654-3765
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8735207U00000X, 2085B0100X, 2085P0229X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
E21336Medicare UPIN